Last week there were 460 people in
intensive care, which has now jumped to 738. There are more than 3,600
intensive care beds with contingency plans in place to double this if
necessary.

The above comments reflect the serious nature of the H1N1 outbreak in
the UK. Last season, the peak number was 180, and at that level
there was a shortage of ECMO machines. The jump to 460
last week raised serious questions about the ability to deliver
appropriate health care to the severe cases. There are only 20
machines in the entire country, and each patient requires 5 days to
three weeks, so on average about 2 machines become available each
day. However, the jump from 302
severe cases on December 20 to 460 on December 24, to 738 on
December 30 indicates the freeing of 2
machines per day, falls far short of the need.

Similarly, these increases severely impact ICU beds, which are
undoubtedly full at this time with the exploding numbers of flu cases,
in addition to other conditions and procedures that require ICU
beds. Thus the necessity for doubling the ICU beds is already
abundantly clear, but the plans to increase ECMO machines are not.

Moreover, the latest HPA report cites increases in Tamiflu resistance,
which will undoubtedly increase the number of severe and fatal cases.
Initial sequence data from four patients demonstrate an evolution
via recombination
away from the current vaccine, as well as immunity elicited toward H1N1
from last season.

The earlier data on fatal cases indicated a majority did not have
pre-existing conditions, and the vaccination uptake in those under 65
who do not have risk factors is abysmal. Similarly, the latest
series of agency comments, which ignore the increasing number of severe
and fatal cases in previously healthy young adults. increases concerns
that the serious nature of the current situation is being lost in sound
bites and head pats.